Should I go gluten-free? I hear this question all the time at my office. Many are hesitant to remove gluten from their life and give up fluffy bread. But often once they embark on a gluten-free journey, they see their symptoms improve.
I’ve been in your shoes. I tried a gluten-free diet ten years ago and never looked back. Years later, genetic testing confirmed what I already knew: gluten is a problem for my body.
In this article, you will learn about the problem with gluten and the main gluten-related health issues. You will learn how to uncover potential gluten-related issues with an elimination diet and use HLA testing so that you can make the right decision for your body.
What Is Gluten?
Gluten is a protein found in many wheat, barley, rye, wheatberries, semolina, durum, spelt, farro, farina, emmer, graham, kamut, einkorn, and the cross between wheat and rye called triticale (1).
Gluten acts as a binder. It is basically a glue that allows certain foods to maintain their shape. It also adds a stretch quality, which, for example, allows bread dough to be shaped into a ball, stretched, folded, or tossed without ripping easily.
Gluten is commonly found in many foods made with glutened grains. However, it is also used in various non-food products, including toothpaste, soaps, lotions, detergents, and capsules.
Foods with Gluten
Many grains, including wheat, barley, rye, spelt, kamut, and tricale contain gluten. Foods made with these ingredients contain gluten and may include:
- Bread, including rolls, buns, bagels, bread loaves, baguettes, flour tortillas, biscuits, and chapati
- Pastry, including croissants, cinnamon rolls, and Danish rolls
- Baked goods, including cakes, cookies, pies, muffins, donuts, pancakes, and waffles
- Cereal and granola
- Crackers
- Gravy, soup, and bouillon cubes
- Soy sauce
- Beer
- Chewing gum
- Communion wafers
Many overly processed foods contain gluten. When it comes to processed foods, you may have to worry about cross-contamination. Cross-contamination is especially problematic if you have celiac disease or a serious gluten allergy.
Non-food products may also use gluten, which can become an issue for patients with celiac disease or gluten allergies. These tend not to be an issue for those with gluten sensitivities.
Hidden sources of gluten in non-food items may include:
- Pills
- Capsules
- Cough drops or syrups
- Vitamin or mineral supplements
- Make-up
- Toothpaste
- Mouthwash
- Soaps
- Shampoo
- Conditioner
- Sunscreen
- Bath salts
- Baby powder
- Lotions and creams
- Lipstick, lip balm, or lip gloss
- Detergents
- Cleaning liquids
- Latex or rubber gloves
- Playdough, paint, glue, and other art supplies
- Stickers, stamps, or envelops due to the glue
- Pet food
Gluten-Related Health Issues
You may develop a variety of gluten-related health issues. Some may require you to seriously avoid gluten, including foods with gluten, non-food products with gluten, and potential gluten contamination.
Celiac Disease
Celiac disease is an autoimmune condition that affects around 1% of the population (2). Essentially, your body treats gluten as a harmful invader. To protect you, it attacks gluten, but in the process, it also damages your gut lining (3). Celiac disease can lead to severe gastrointestinal problems, nutrient deficiencies, anemia, and other health issues. Symptoms may include bloating, constipation, diarrhea, belly aches, tissue damage in your small intestines, weight loss, fatigue, headaches, migraines, rashes, and depression. Not everyone has digestive symptoms, which makes celiac disease difficult to spot. According to one study, about 80% of people diagnosed with celiac didn’t previously know or suspect they had it (3).
Wheat Allergy
About 0.2 to 1% of children have a wheat allergy (4). About 65% of children ‘outgrow’ their wheat allergy by the time they reach age 12 without treatment (5). Some may experience symptoms into adulthood.
Wheat allergy is not an allergy to gluten specifically. If you have a wheat allergy, you may be able to eat non-wheat grains with gluten, such as rye or barley, without issues. However, since wheat allergy can compromise your gut health and lead to digestive symptoms, it may make you more prone to gluten sensitivities as well.
Non-Celiac Gluten Sensitivity
Even if you don’t have celiac disease or a wheat allergy, you may experience gluten-related symptoms. Officially, somewhere between 0.5 and 13% of the population has non-celiac gluten sensitivity (6). However, in the functional medicine world, we find that a lot more people have symptoms related to gluten and benefit from a gluten-free diet.
Non-celiac gluten sensitivity has no clear definition (7). Diagnosis is usually made when celiac disease and allergies are ruled out, but the patient is still experiencing negative symptoms from gluten. Symptoms of non-celiac gluten sensitivity may include stomach pain, bloating, gas, diarrhea, constipation, fatigue, sleep issues, and depression.
However, it’s important to look for other potential root issues behind your symptoms. A 2014 study published in Digestion looked at 392 people with self-diagnosed gluten sensitivity. They found that 26 participants had celiac disease, 2 had wheat allergies, and 27 had official gluten sensitivity (8). According to the study, the rest of them might’ve had other issues. In many, a gluten-free diet may lead to improvements due to removing gluten as a trigger. In others, it may simply help to reduce processed foods, lower sugars, or decrease inflammation, causing a reduction of symptoms.
Molecular Mimicry and Thyroid Health
Gluten may be a trigger for other autoimmune diseases beyond celiac disease due to molecular mimicry. Molecular mimicry means that two compounds that are structurally similar can fit into the same receptors. This may disrupt physiological processes (9, 10).
Gluten is structurally similar to several of your body’s tissues, especially your thyroid gland. If your body recognizes gluten as an invader, it may mistake it for structurally similar tissues, such as thyroid tissues. It may end up attacking its own cells, leading to Hashimoto’s, for example, an autoimmune thyroid condition. Casein, a protein found in dairy, is another doppelganger for your thyroid, potentially causing similar issues due to molecular mimicry.
Gluten and Other Issues
Gluten may be a factor in many other health issues. Research and experience have found that following a gluten-free diet may be beneficial for patients even without celiac disease, wheat allergies, or official gluten sensitivity.
A 2019 study published in the Journal of Family Medicine and Primary Care has found that patients with irritable bowel syndrome (IBS) may benefit from a gluten-free diet (11). According to a 2021 review published in Nutrients, a gluten-free diet may help children with autism (12). I have found the same working with patients with autism in the past 25 years.
A 2018 review published in Advances in Nutrition has found that a gluten-free diet may be helpful for those with schizophrenia (13). According to a 2018 review published in Nutrients, gluten may play a role in mood disorders, too (14).
Clearly, a gluten-free diet may be an idea to try for a variety of chronic symptoms and chronic conditions. Gluten may also increase chronic inflammation in the body, which is an underlying issue in most modern-day diseases (15).
Should You Go Gluten-Free?
So, should you be removing gluten from your diet? It depends. Many people I work with have benefitted from a gluten-free diet.
Clearly if celiac disease is suspected, then testing for it with a blood screen, called a celiac panel, should be undertaken. Patients with celiac disease need to be much more strict with gluten avoidance, beyond the diet even. The panel needs to be done before gluten has been excluded from your diet. If the test is okay, but you still suspect issues with gluten, unrelated to celiac disease, further digging might be necessary.
You may try an elimination diet by simply removing gluten for 3 to 4 weeks to see if your symptoms improve. If they do, you may have gluten-related issues and can extend the diet further. If you are experiencing symptoms once reintroducing gluten, say after 3 months, you can probably benefit from a gluten-free diet.
You may also try HLA genetic testing to uncover underlying gluten-related issues. It has helped many of my patients and has confirmed my own gluten-related symptoms.
HLA Genetics Testing
I’ve been gluten-free for about 10 years. Clinically, it made a lot of sense to me based on the symptoms I was getting. Gluten-free is not for everybody. It’s a medical decision that should be made in conjunction with your healthcare provider.
I personally did some genetic profiling after about 6 or 7 years of being gluten-free. It’s called human leukocyte antigen or HLA genetic testing (16). It can test if you are predisposed to celiac disease and may also aid the diagnosis of celiac disease or other gluten-related issues.
It is available in some DNA panels we can do in clinics and functional medicine. For me, it showed that I was at high risk of having celiac disease and gluten sensitivity, thus, it validated that being gluten-free was right for me.
I have used this test with my patients with great results. If you don’t have celiac disease or a gluten allergy but suspect that you may have gluten-related health issues, food sensitivity testing or removing gluten as part of an elimination diet can provide some great insights. HLA genetic testing can provide even further insight that gluten-free may be right for you.
Gluten-free eating can make a huge difference in many in terms of inflammation, pain, and chronic symptoms. Symptoms are not always gut symptoms. I personally tend to get a headache when I’m exposed to gluten. So, checking for gluten-related issues can be a good idea for other chronic symptoms.
Gluten-Free Options
It goes without saying that the bulk of our diet should be void of gluten-free grain or similar substitutes. This means that fruits and vegetables, all of which are gluten-free, should make up a large proportion of our daily consumption. An apple is gluten-free; so are lettuce, broccoli, bell peppers, and so on. Even protein options, such as meat, poultry and fish, are gluten free choices. Basically I eat a gluten-free Mediterranean diet with as many hormone-free, pesticide free options as possible. Very very rarely do I eat bread of any sort; I haven’t had a slice in 6 months. Cereal? Not in many years, again even the gluten-free variety. And I grew up eating plenty of Wonder Bread, every kind of boxed cereal, pasta – as well as a whole host of pastry products. Are Twinkies still a thing, or did I eat them all as a youngster?!! Make no mistake, there IS gluten-free junk food.
It can be hard to remove gluten from the diet if you’re used to consuming it, but here are some common gluten-free options that substitute for customary gluten-based staples:
- Pseudograins, such as quinoa and amaranth
- Rice, including jasmine rice, basmati rice, and wild rice (look for basmati from California to avoid metals)
- Potatoes, sweet potatoes, or yam
- Spaghetti squash
- Chickpea pasta, quinoa pasta, soba noodles, rice noodles, and other gluten-free pasta
- Zucchini noodles and other spiralized vegetables
- Bread and baked goods with almond flour or other nut flour
- Cauliflower pizza crust and other cauliflower-based ‘bready’ recipes
- Cauliflower rice or cauliflower couscous (ground cauliflower)
- Wraps with lettuce or leafy greens
- Rice wraps or sushi wraps
- Sweet potato toast
- Eggplant, large mushrooms, or bell peppers to replace the bun in burgers and sandwiches
- Bread or pancakes made with coconut flour, such as coconut flour butternut squash bread or coconut flour pancakes
Remember, if you have celiac disease or very serious reactions to gluten, avoiding potential cross-contamination and non-foot products with gluten is critical.
Next Steps
Are you dealing with gluten-related symptoms? Do you need to reduce or eliminate gluten from your diet? Do you need help? Looking at your nutrition is key to better wellness. If you want to know more about how nutrition and healthy dietary strategies may improve your health, follow my blog or schedule a consultation for personalized advice.
If you are dealing with any chronic health issues and need advice on how to improve your nutrition and health, I welcome you to start a functional medicine consultation with me for further personalized guidance. You may book your consultation here.
Check out my Histamine Intolerance Course here. Learn on your own time, from anywhere. Get an inside look at the most helpful functional medicine tests for pinpointing imbalances, ways to identify and manage the most common (and sometimes surprising) mast cell triggers, and learn what to eat, what to avoid, and why.
